Application for Replacement/Initial Nonimmigrant Arrival-Departure Document

OMB No. 1615-0079; Expires 08/31/2012

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions for I-102, Application for Replacement/
Initial Nonimmigrant Arrival-Departure Document
Instructions

Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet of paper. Write your name and Alien Registration Number (A-Number), if you have one, at the top of each
sheet and indicate the number of the item to which the answer refers.

What Is the Purpose of This Form?
Use Form I-102 to request a new or replacement of an
incorrect, lost, stolen, or damaged Nonimmigrant ArrivalDeparture Document.

When Should I Use This Form?
As a nonimmigrant visitor to the United States, you should
use Form I-102 to apply to U.S. Citizenship and Immigration
Services (USCIS) for a new or replacement:

2.

3. Receive a corrected Form I-94, I-94W, or I-95 if you were
issued one with incorrect information when you entered as
a nonimmigrant or refugee; or
4. Receive an initial Form I-94 if you were not issued one
when you were originally admitted into the United States
due to your military membership as described below:
A. Nonimmigrant member of the U.S. Armed Forces; or

1. Form I-94, Nonimmigrant Arrival-Departure Record;

B. Nonimmigrant member of the North Atlantic Treaty
Organization (NATO) armed forces or civilian
component; or

2. Form I-94W, Nonimmigrant Visa Waiver ArrivalDeparture Record; or

C. Nonimmigrant member of the Partnership for Peace
military program under the Status of Forces
Agreement (SOFA).

3. Form I-95, Crewman Landing Permit.

How Do I File This Form?

Receive an initial Form I-94 if you were not issued one
when you entered as a nonimmigrant, and you are filing
this form with an application for extension of stay or
change of status;

Step 1 - Identify reason for Filing Form I-102

ADVISORY: Do not use this form to request an action on
Form I-94 issued by the U.S. Customs and Border Protection
(CBP). If you are seeking a new Form I-94 based on a Form
I-94 issued at a port of entry or otherwise by CBP, you should
contact the nearest CBP office or port of entry and inquire
about their procedures, or visit the CBP's Web site at
www.cbp.gov.

Step 2 - Fill Out Form I-102

Step 2. Fill Out Form I-102

Step 3 - Submit Your Application

1. Type or print legibly in black ink.

A separate Form I-102 must be filed for each person seeking
the immigration benefit. Follow the steps below to complete
your application:

General Instructions
Step 1. Reason for Filing Form I-102
The following is a brief description of eligibility categories.
Check the box in Part 2 of Form I-102 that matches your
reason for filing.
After determining which category best applies, you must
submit evidence that proves eligibility. Each category has
specific evidence requirements. See Step 3, Submit Your
Form I-102, for information on what evidence is required.
You should use Form I-102 to:
1. Replace your lost, stolen, or mutilated Form I-94, I-94W,
or I-95;

2.

If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.

3.

Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
write "None."

This form is divided into Parts 1 through 5. The following
information should help you fill out the form.

Part 1. Information About You
1.

Family Name (Last name) - Give your legal name. If
you have two last names, include both and use a hyphen
(-) between the names, if appropriate.

2.

Address - Give your physical street address. This must
include a street number and name or a rural route number.
Do not put a post office box (P.O. Box) number here.
Form I-102 Instructions (Rev. 08/20/10)Y

3. A-Number - This is your immigration file number. If
you do not have an Alien Registration Number or do not
know it, leave this blank.
4. U.S. Social Security Number - If you do not have a U.S.
Social Security Number, leave this blank.
A. Date of Last Admission - Give the day of your last
actual entry into the United States.
B. Current Nonimmigrant Status - Give your current
status. If you were granted a change of status, provide
the receipt notice noting the change.
C. Expires On - Give the day your authorized stay in the
United States ends.
D. Numbers on Form I-94, I-94W, or I-95 ArrivalDeparture Document - Give the number that is at the
top of the document you originally received at the time
of entry. If you did not receive Form I-94 at entry,
write "N/A."

Part 2. Reason for Application
Place a check in the box that corresponds with your reason for
filing.

Part 3. Processing Information
Numbers 1 - 3 - Give all information requested.

Part 4. Signature
1. As the applicant, you must sign and date the application.
If you do not sign the form, it will be returned as
incomplete.
2. Daytime Telephone Number - Give a phone number
with the area code where you can be reached during the
day.

Part 5. Signature of Person Preparing Form, if
Other than Applicant
If you, the applicant, did not fill out Form I-102, the preparer
must also sign, date, and give his or her address, daytime
phone number, and fax number.

Step 3. Submit Your Application
Your application must include the following items:
1. Your Signed and Completed Form I-102. Each
application must be properly signed and filed with the
correct fee. If you are under 14 years of age, your parent
or guardian may sign the application.
2. General Requirements
A. Initial Evidence. You must file your application with
the required initial evidence. Attach copies, showing
the front and back of the documents you need to
support your application. Do not send original
documents unless instructed to do so.

B. Lost or Stolen Form. If you are applying to replace a
lost or stolen Form I-94, I-94W, or I-95, submit a copy
of the original or submit a copy of the biographic page
from your passport and a copy of the page indicating
admission as claimed, or other evidence of your
admission. If you are unable to provide this evidence,
submit a full explanation stating why you cannot give
any of the above evidence, along with a copy of
evidence of your identity and copies of any evidence
in your possession to substantiate your claim. If your
card was stolen, submit a copy of the police report
relating to the theft.
C. Mutilated Form. If you are applying to replace a
mutilated Form I-94, I-94W, or I-95, attach the
original damaged form.
D. First Form I-94. If you were not issued Form I-94 at
admission and have not since been issued Form I-94,
but now require Form I-94 for another application you
are filing, submit a copy of any evidence in your
possession to substantiate your claimed admission.
E. Nonimmigrant Military Member. If you are filing as
a nonimmigrant military member in the U.S. Armed
Forces, NATO, or the Partnership for Peace program
and you are requesting an initial Form I-94, contact
your foreign commander or his or her designee in the
United States for filing information.
F. Correct Inaccurate Information. If you want USCIS
to correct inaccurate information on your Form I-94,
I-94W, or I-95, attach your Form I-94, I-94W, or I-95
to your application. If you check box "f" on Part 2,
Application Type, attach a statement dated and signed
by you, citing specifically what information on your
Form I-94, I-94W, or I-95 requires correction. You
must also attach evidence verifying the validity of the
information submitted for correction purposes.

Translations

Any document containing a foreign language submitted to
USCIS shall be accompanied by a full English language
translation which the translator has certified as complete and
accurate, and by the translator's certification that he or she is
competent to translate from the foreign language into English.

Copies

Unless specifically required that an original document be filed
with an application or petition, an ordinary legible photocopy
may be submitted. Original documents submitted when not
required will remain a part of the record, even if the
submission was not required.

Where to File?
NOTE: The following instructions relate only to Form I-102
issued by USCIS. To request an action on Form I-94 issued
by CBP, refer to the Advisory under Step 1, Reason for
Filing Form I-102 on Page 1 of these instructions.
Form I-102 Instructions (Rev. 08/20/10)Y Page 2

Please note the USCIS filing locations for this form are
subject to change. Read the instructions carefully to determine
where to send your application.
The filing addresses provided on this form reflect the most
current information as of the date this form was last printed.
If you are filing Form I-102 more than 30 days after the latest
edition date shown in the lower right corner, visit us online at
www.uscis.gov before you file, and check the "FORMS" page
to confirm the correct filing address and form version
currently in use. Check the edition date located in the lower
right corner of the form. If the edition date on your Form
I-102 matches the edition date listed for Form I-102 on the
online "FORMS" page, your version is current. If the edition
date on the online version is later than your version, download
a copy and use it. If you do not have Internet access, call
Customer Service at 1-800-375-5283 to verify the current
filing address and edition date.
Filing Locations:
1. If you are submitting Form I-102 with another form,
submit both forms according to the filing instructions for
the other form.
2. If you are submitting Form I-102 by itself to:
A. Replace your lost or stolen Form I-94 (or I-94W)
(Box "a");
B. Replace your lost or stolen Form I-95 (Box "b");
C. Replace Form I-94 (or I-94W) because it is mutilated
(Box "c");
D. Replace Form I-95 because it is mutilated (Box "d");
E. Correct information on your Forms I-94, I-94W, or
I-95. If I-94, I-94W or I-95 was issued by USCIS with
incorrect information (Box "f"), attach your original
forms I-94, I-94W, or I-95. If the error was caused by
your submission of incorrect information, you must
include the appropriate fee. If the error was due to
USCIS error, no fee is required;
F. Obtain a Form I-94 because you did not receive it when
you entered the United States as a nonimmigrant
member of the U.S. Armed Forces (Box "g").
Mail your application to the USCIS Phoenix or Dallas
Lockbox facility, based on where you are located. See filing
instructions below.
If you are located in:
Alabama, Arkansas, Connecticut, Delaware, the District of
Columbia, Florida, Georgia, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Mississippi, New Hampshire, New
Jersey, New Mexico, New York, North Carolina, Oklahoma,
Pennsylvania, Puerto Rico, Rhode Island, South Carolina,
Tennessee, Texas, Vermont, Virginia, U.S. Virgin Islands,
West Virginia

Mail your application to:
USCIS Dallas Lockbox:
For U.S. Postal Service:
USCIS
PO Box 660867
Dallas, TX 75266
For Express mail and courier deliveries:
USCIS
Attn: AOS
2501 S. State Hwy. 121 Business
Suite 400
Lewisville, TX 75067
If you are located in:
Alaska, Arizona, California, Colorado, Guam, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota,
Missouri, Montana, Nebraska, Nevada, North Dakota, Ohio,
Oregon, South Dakota, Utah, Washington, Wisconsin,
Wyoming, Guam, or the Commonwealth of Northern Mariana
Islands
Mail your application to:
USCIS Phoenix Lockbox:
For U.S. Postal Service:
USCIS
PO Box 21281
Phoenix, AZ 85036
For Express mail and courier deliveries:
USCIS
Attn: AOS
1820 E. Skyharbor Circle S
Suite 100
Phoenix, AZ 85034
Not Issued Form I-94/Extension - Status Change
If you were not issued Form I-94 at admission or are filing
this application with a Form I-539, Application to Extend/
Change Nonimmigrant Status (Box "e"), file this application
in accordance with Form I-539 filing instructions.
NATO and SOFA Military Members
If you are filing Form I-102 because you are a military
member of NATO or Partnership for Peace under SOFA (Box
"g"), and are seeking an initial Form I-94, submit this
application through your foreign commander or his or her
designee to NATO/Headquarters, Supreme Allied Commander
Transformation (NATO/HQ SACT) at:
NATO/HQ SACT
7857 Blandy Road, Suite 100
ATTN: Legal Affairs
Norfolk, VA 23551-2490
Form I-102 Instructions (Rev. 08/20/10)Y Page 3

E-Notification

If you are filing your Form I-102 at one of the USCIS
Lockbox facilities, you may elect to receive an e-mail and/or
test message notifying you that your application has been
accepted. You must complete Form G-1145, E-Notification of
Application/Petition Acceptance, and clip it to the first page of
your application. To download a copy of the Form G-1145,
including the instructions, refer to www.uscis.gov "FORMS".

What Is the Filing Fee?
The filing fee for Form I-102 is $330.
1. The fee must be submitted in the exact amount. It cannot
be refunded. Do not mail cash.
2. You do not need to pay the fee to request USCIS to correct
your Form I-94, I-94W, or Form I-95 if the error(s) on
your document was made by USCIS, through no fault of
your own. If, however, the error(s) was made because of
information you provided or failed to provide to USCIS or
the U.S. Department of State, you must pay the fee.
3. You do not need to pay the fee if you are a nonimmigrant
military member in the U.S. Armed Forces or you are
participating in a NATO or Partnership for Peace military
program under the SOFA and you are requesting an initial
or replacement Form I-94.
4. Use the following guidelines when you prepare your check
or money order:
A. The check or money order must be drawn on a bank or
other financial institution located in the United States
and must be payable in U.S. currency; and
B. Make the check or money order payable to U.S.
Department of Homeland Security, unless:
1. If you live in Guam and are filing your application
there, make it payable to Treasurer, Guam.
2. If you live in the U.S. Virgin Islands and are filing
your application there, make it payable to
Commissioner of Finance of the Virgin Islands.
3. If you live outside the United States, Guam, or the
U.S. Virgin Islands, contact the nearest U.S.
Embassy or consulate for instructions on the
method of payment.
NOTE: Please spell out U.S. Department of Homeland
Security; do not use the initials "USDHS" or "DHS."
Notice to Those Making Payment by Check
If you send us a check, it will be converted into an electronic
funds transfer (EFT). This means we will copy your check
and use the account information on it to electronically debit
your account for the amount of the check. The debit from
your account will usually take 24 hours and will be shown on
your regular account statement.

You will not receive your original check back. We will
destroy your original check, but we will keep a copy of it. If
the EFT cannot be processed for technical reasons, you
authorize us to process the copy in place of your original
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times.

How to Check if the Fees Are Correct
The form and biometric fees on this form are current as of the
edition date appearing in the lower right corner of this page.
However, because USCIS fees change periodically, you can
verify if the fees are correct by following one of the steps
below:
1. Visit our Web site at www.uscis.gov, select "FORMS,"
and check the appropriate fee;
2. Review the Fee Schedule included in your form package, if
you called us to request the form; or
3. Telephone our National Customer Service Center
at 1-800-375-5283 and ask for the fee information.

Address Changes
If you change your address and you have an application or
petition pending with USCIS, you may change your address
online at www.uscis.gov. Click on "Online Change of
Address" and follow the prompts. You may complete and mail
Form AR-11, Alien's Change of Address Card, to:
U.S. Citizenship and Immigration Services
Change of Address
P.O. Box 7134
London, KY 40742-7134
For commercial overnight or fast freight services only, mail to:
U.S. Citizenship and Immigration Services
Change of Address
1084-I South Laurel Road
London, KY 40744

Processing Information
Our goal at USCIS is to process all applications fairly. The
processing time will vary, depending on the specific
circumstances of each case. We may deny an application if
you do not give us the requested information or do not go to a
scheduled interview. Each application must be properly
signed with the correct fee. If you are under 14 years of age,
your parent or guardian may sign the application.

Form I-102 Instructions (Rev. 08/20/10)Y Page 4

Acceptance
Any Form I-102 that is not signed or accompanied by the
correct fee will be rejected with a notice that Form I-102 is
deficient. You may correct the deficiency and resubmit the
application. However, an application is not considered
properly filed until it is accepted by USCIS.
Initial Processing
Once Form I-102 has been accepted, it will be checked for
completeness, including submission of the required initial
evidence. If you do not completely fill out the form or file it
without the required initial evidence, you will not establish a
basis for eligibility, and we may deny your Form I-102.
Decision
You will be notified in writing of the decision on your
application. If the application is approved, a new Form I-94 or
Form I-95 will be issued to you.

USCIS Forms and Information
To order USCIS forms, call our toll-free number at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations, and procedures
by telephoning our National Customer Service Center at
1-800-375-5283 or visiting our Internet Web site at
www.uscis.gov.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our Internet-based system, InfoPass. To access the system,
visit our Web site. Use the InfoPass appointment scheduler
and follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
appears on the screen.

Privacy Act Notice
We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-102.

Paperwork Reduction Act
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 25 minutes per
response, including the time for reviewing instructions, and
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Products Division, 111 Massachusetts Avenue,
N.W., 3rd Floor, Suite 3008, Washington, DC 20529-2210.
OMB No. 1615-0079. Do not mail your application to this
address.

Penalties
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this Form I-102, we will
deny your Form I-102 and may deny any other immigration
benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.

Form I-102 Instructions (Rev. 08/20/10)Y Page 5